社区获得性、医疗保健相关性和医院获得性菌血症的临床特征、抗菌药物耐药性和荚膜型。
Clinical characteristics, antimicrobial resistance and capsular types of community-acquired, healthcare-associated, and nosocomial bacteremia.
机构信息
1Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Number 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217 Taiwan.
2Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
出版信息
Antimicrob Resist Infect Control. 2019 Jan 3;8:1. doi: 10.1186/s13756-018-0426-x. eCollection 2019.
BACKGROUND
bacteremia is a major cause of morbidity and mortality worldwide. We aimed to compare the clinical characteristics, distribution of capsular types, and antimicrobial resistance of bacteremia among community-acquired (CA), healthcare-associated (HCA), and nosocomial infections.
METHODS
This retrospective study of patients with bacteremia was conducted at Taipei Veterans General Hospital from January to December 2015. Clinical characteristics of bacteremia were collected. The isolates were subjected to antimicrobial susceptibility testing and capsular genotyping.
RESULTS
In total, 337 patients with bacteremia were identified: 70 (20.8%), 102 (30.3%), and 165 (48.9%) presented with CA, HCA, and nosocomial infection, respectively. The 28-day mortality of HCA bacteremia was lower than that of nosocomial bacteremia (17.6% versus 30.9%, = 0.016); however, that of the HCA and CA bacteremia was similar (17.6% versus 14.3%, = 0.557). CA isolates had the highest prevalence of virulent capsular types (51.4%), followed by HCA (36.3%) and nosocomial isolates (19.4%). The proportion of multidrug-resistant (MDR) isolates was highest in nosocomial infections (41.8%), followed by HCA (23.5%) and CA infections (5.7%).
CONCLUSION
CA, HCA and nosocomial are distinct entities, as evidenced by the differences in clinical characteristics, antimicrobial resistance, and capsular types found in this study.
背景
菌血症是全球发病率和死亡率的主要原因。我们旨在比较社区获得性（CA）、医疗保健相关性（HCA）和医院获得性感染的菌血症的临床特征、荚膜型分布和抗菌药物耐药性。
方法
这项回顾性研究是在 2015 年 1 月至 12 月期间在台北荣民总医院对菌血症患者进行的。收集菌血症患者的临床特征。对分离株进行抗菌药物敏感性试验和荚膜基因分型。
结果
共确定 337 例菌血症患者：70 例（20.8%）、102 例（30.3%）和 165 例（48.9%）分别为 CA、HCA 和医院获得性感染。HCA 菌血症的 28 天死亡率低于医院获得性菌血症（17.6%比 30.9%，=0.016）；然而，HCA 和 CA 菌血症的死亡率相似（17.6%比 14.3%，=0.557）。CA 分离株的毒力荚膜型患病率最高（51.4%），其次是 HCA（36.3%）和医院分离株（19.4%）。耐多药（MDR）分离株的比例在医院感染中最高（41.8%），其次是 HCA（23.5%）和 CA 感染（5.7%）。
结论
CA、HCA 和医院获得性感染是不同的实体，本研究发现它们在临床特征、抗菌药物耐药性和荚膜型方面存在差异。
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